Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS039419 | PA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 059477 | NY |
N | 204E00000X | Oral & Maxillofacial Surgeon | DS039419 | PA |
NPI | 1528222080 |
---|---|
Provider Name | Dr. Justin J Au |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-9800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2008 |
Last Update Date | 17/08/2020 |